Manager, Medical Coding and Risk Adjustment

Job Details
Bachelors degree is required
Manager, Medical Coding and Risk Adjustment
This role is responsible for the leadership, management and monitoring of revenue cycle process, specific to clinical documentation improvement and risk adjustment coding initiatives for Prospect Provider Group IPAs in CT, NJ and PA. This person is responsible for the development of a Risk Adjustment Program related to clinical documentation improvement related to chronic conditions and/or procedures, provider education and the granularity of diagnosis documentation and available code sets, and associated reporting. In addition, this role provided oversight and strategic direction for the daily operational activities of the Coding team.
Responsible for the supervision of staff, including hiring, training, and review performance of employees.
In regard to Clinical Documentation Improvement and Diagnosis Accuracy this position will ensure effective communication and strong collaboration with the Health Plan and Prospect Provider Group providers.
Responsible for the oversight of all Risk Adjustment Initiatives coordinated with health plans. Leads or participates in internal analysis and monitors status of initiatives and goals. Provides analysis and reporting on progress and results.
Serves as a primary contact for Prospect Provider Group providers and leaders regarding Risk Adjustment initiatives. Must have comprehensive understanding of multiple risk adjustment methodologies (i.e. HCC, ACG, HHS-HCC, ACA, etc.).
Participated in defining Risk Adjustment and the importance of diagnosis accuracy and its like to Total Cost of Care measurements.
Demonstrates knowledge of EHR (i.e. GE Centricity, AllScripts, Cerner, etc.) clinical/charge capture functionality and partners with EHR developers to optimize existing functionality and/or identifies coding tools/systems that work with designated EHR.
Assists team members with daily responsibilities. Demonstrates leadership by providing daily direction and guidance for team members.
Provides coding education to providers and clinical staff across multiple markets.
Through medical record documentation review compiles, analyzes and presents data to clinical and medical management teams.
Educates and provides feedback to physicians and other providers on the diagnosis accuracy issues.
Bachelor's degree in business administration, public health, healthcare administration, health information management or other related fields.
Three years of health care management experience, including at least two years in a supervisory level position in Coding Services or similar health care coding or billing functions.
Certified Professional Coder (CPC, CCSP, or other coding certification)
Knowledge of CPT/HCPCS procedural and ICD diagnosis coding.
Two years documented project or program management experience; including development of work plans and tools for monitoring performance of initiatives.
Demonstrated leadership and organization skills.
Ability to present information in one-on-one and group settings.
Ability to communicate information in a professional and confident manner.
Demonstrated ability in critical thinking, self-initiative, and self-direction.
Must understand and be able to apply Center for Medicare and Medicaid Documentation Guidelines and Third Party Payer Reimbursement Policies and Procedures.
Ability to motivate and elevate a team of professionals
Preferred Qualifications
Risk Adjustment Diagnosis coding experience

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